Racial Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors in UK Biobank and Korean NHIS-HEALS cohort studies.

Abstract

Background: The increasing prevalence of atrial fibrillation (AF) requires efforts to understand racial differences in disease distribution and risk factors.

Objective: To compare associations between risk factors and AF in white Europeans from the UK Biobank and Asians from the KNHIS-HEALS (Korean National Health Insurance Service-Health Screening) study.

Methods: This study included participants from the KNHIS-HEALS and UK Biobank, respectively. After matching for age and sex, 185,904 participants in KNHIS-HEALS and 185,904 participants in UK Biobank were enrolled in the study. The incidence of AF, its associations with biomarkers, prevalent cardiovascular disease, and population-attributable risk by race.

Results: During a median follow-up (KNHIS-HEALS 7.1 years, UK biobank 11.9 years), compared to population in KNHIS-HEALS, those in UK biobank showed higher incidence and risk of AF (3.99 vs. 3.41 per 1000 person-years; hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.15-2.25). Body mass index (BMI), systolic blood pressure, alcohol, heart failure, myocardial infarction, or stroke were associated with an increased risk of new-onset AF in both cohorts. Among them, higher BMI and smoking were more strongly related to the increased risk of new-onset AF in UK Biobank compared to KNHIS-HEALS, with a relative risk ratio of 1.21 (95% CI, 1.17- 1.25) and 1.12 (95% CI, 1.02-1.21), respectively.

Conclusion: In this first large-scale comparison of Caucasian and Asian populations, the cumulative risk of developing AF was higher in the UK than in Korea. Higher BMI and smoking were associated with a higher risk of AF in the UK than in Korea.